Diagnostic Accuracy of Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-Analysis

OBJECTIVES: Right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension. However, echocardiography is frequently used to screen for this disease and monitor progression over time because it is noninvasive, widely available, and relatively inexpensive. The objective of our study was to perform a systematic review and quantitative meta-analysis to determine the correlation of pulmonary pressures obtained via echocardiography versus right heart catheterization and to determine the diagnostic accuracy of echocardiography for pulmonary hypertension.

METHODS: MEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched and were inclusive as of February 2010. Studies were only included if a correlation coefficient or the absolute number of true-positive, false-negative, true-negative, and false-positive observations were available, and the “reference standards” were described clearly. Quality was assessed with the Quality Assessment for Diagnostic Accuracy Studies (QUADAS). A random effects model was used to obtain a summary correlation coefficient and the bivariate model for diagnostic meta-analysis was used to obtain summary sensitivity and specificity values.

RESULTS: Twenty-nine studies were included in the meta-analysis. The summary correlation coefficient between systolic pulmonary arterial pressure estimated from echocardiography versus measured by right heart catheterization was 0.70 (95% CI: 0.67-0.73) (n=27). The summary sensitivity and specificity for echocardiography for diagnosing pulmonary hypertension was 83% (95% CI: 73-90) and 72% (95% CI: 53-85) (n=12), respectively. The summary diagnostic odds ratio was 13 (95% CI: 5-31).

CONCLUSIONS: Echocardiography is a useful and noninvasive modality for measuring pulmonary pressures and for screening/diagnosing pulmonary hypertension. 


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One Comment

  1. Meta-analysis of an important and interesting subject. There is another recently published meta-analysis on the smae topic:

    Diagnostic value of transthoracic Doppler echocardiography in pulmonary hypertension: a meta-analysis.
    Zhang RF, Zhou L, Ma GF, Shao FC, Wu XH, Ying KJ.


    BACKGROUND: A commonly used noninvasive method, transthoracic Doppler echocardiography (TDE) has been widely recommended for the diagnosis of pulmonary hypertension (PH). We aimed to review comprehensively the evidence for the use of TDE to diagnose PH.
    METHODS: After a systematic review of English-language studies, we used random-effects models to pool sensitivity, specificity, and other measures of accuracy of TDE for the diagnosis of PH. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance.
    RESULTS: Six studies met our inclusion criteria. The summary estimates for TDE in the diagnosis of PH in the included studies were as follows: sensitivity, 0.82 (95% confidence interval (CI), 0.76-0.88); specificity, 0.68 (95% CI, 0.64-0.72); positive likelihood ratio (PLR), 2.88 (95% CI, 1.77-4.70); negative likelihood ratio (NLR), 0.31 (95% CI, 0.18-0.53); and diagnostic odds ratio (DOR), 11.36 (95% CI, 4.62-27.94).
    CONCLUSIONS: Current evidence suggests that TDE is a test with acceptable mixed sensitivity, but in isolation, it has insufficient specificity for detecting PH. It may be useful as a first-line surveillance modality in patients in whom PH is suspected. The value of the combination of TDE with other noninvasive methods for PH detection warrants further investigation.

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